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dc.contributor.authorChoulagai, Bishnu Prasad
dc.date.accessioned2017-05-18T09:14:32Z
dc.date.available2017-05-18T09:14:32Z
dc.date.issued2017-05-18
dc.identifier.isbn978-91-629-0186-8 (PDF)
dc.identifier.isbn978-91-629-0165-1 (Print)
dc.identifier.urihttp://hdl.handle.net/2077/51738
dc.description.abstractBackground Skilled birth attendants (SBAs) provide important services that improve maternal and newborn health and reduce maternal and newborn mortality. Utilization and coverage of SBA services reveal wide disparities between the rural and urban areas of Nepal. Aims This thesis aimed to identify the barriers to SBA service utilization in Nepal and develop and test a community intervention to address those barriers and increase service utilization. Methods Mixed-methods research was applied to identify barriers to SBA service utilization, followed by an intervention to address those barriers. Status of SBA service utilization and associated factors were investigated using cross-sectional surveys in rural settings of mid- and far-western Nepal and in an urban setting in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal. The qualitative study explored perceptions of service users and providers regarding barriers to SBA service utilization and suggestions to overcome those barriers. After identifying such barriers, we designed, implemented, and evaluated a five-component community intervention. The intervention was designed as a cluster-randomized controlled trial involving 36 Village Development Committees. Results Cross-sectional surveys showed that the utilization of SBA services at delivery was 48% in mid- and far-western Nepal and 93.1% in the JD-HDSS. Distance to a health facility and inadequate transport were major barriers to SBA service utilization. Similarly, inadequate knowledge of women and their families regarding the importance of SBA services and low prioritization of birth care hindered such utilization. Women’s knowledge of danger signs of pregnancy and delivery and their educational attainment were determining factors in SBA service utilization. Women who had completed at least four antenatal care (ANC) visits were more likely to use skilled birth care. Our one-year intervention was associated with increased use of skilled birth care services (OR=1.57; CI: 1.19–2.08). However, there was no significant association of the intervention with the use of ANC services. Conclusions There is an urgent need to increase the utilization of SBA services in rural areas of Nepal and address the rural–urban gap in such utilization. An effective intervention for increasing SBA utilization includes mobilizing active community groups, improving service quality and physical infrastructure at health facilities, providing adequate SBAs at health facilities, and implementing longer-term and repeated interventions. Community mobilization efforts are effective, but such efforts require supervision and support to ensure quality of the implementation.sv
dc.language.isoengsv
dc.relation.haspartI. Choulagai B, Onta S, Subedi N, Mehata S, Bhandari GP, Poudyal A, Shrestha B, Mathai M, Petzold M, Krettek A. Barriers to using skilled birth attendants' services in mid- and far-western Nepal: a cross-sectional study BMC International Health and Human Rights 2013; 13:49. ::DOI::10.1186/1472-698X-13-49sv
dc.relation.haspartII. Onta S*, Choulagai B*, Shrestha B, Subedi N, Bhandari GP, Krettek A. Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study (*Shared first authorship) Global Health Action 2014; 7:24580. ::DOI::10.3402/gha.v7.24580sv
dc.relation.haspartIII. Choulagai BP, Aryal UR, Shrestha B, Vaidya A, Onta S, Petzold M, Krettek A. Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants Global Health Action 2015; 8:29396. ::DOI::10.3402/gha.v8.29396sv
dc.relation.haspartIV. Choulagai BP, Onta S, Subedi N, Bhatta DN, Shrestha B, Petzold M, Krettek A. A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal. Health Policy and Planning 2017 May 4. ::DOI::10.1093/heapol/czx045sv
dc.subjectPublic healthsv
dc.subjectEpidemiologysv
dc.subjectMaternal healthsv
dc.subjectNewborn healthsv
dc.subjectInterventionsv
dc.subjectCluster-randomized controlled trialsv
dc.subjectHealth services researchsv
dc.subjectImplementation researchsv
dc.subjectMixed-methods researchsv
dc.subjectNepalsv
dc.titleSkilled birth attendant services in Nepal: overcoming barriers to utilizationsv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailbishnu.p.choulagai@gu.sesv
dc.gup.mailbishnuc@gmail.comsv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInst of Medicine. Department of Internal Medicine and Clinical Nutritionsv
dc.gup.defenceplaceFredagen den 9 juni 2017, kl. 9.00, Hörsal Arvid Carlsson, Academicum, Medicinaregatan 3, Göteborgsv
dc.gup.defencedate2017-06-09
dc.gup.dissdb-fakultetSA


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